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A 27-year-old black female with recently diagnosed HIV infection (CD4+ T cells 9/μl; viral load >106 copies/ml) was admitted to the hospital with diarrhoea, malaise, weight loss and ‘heavy legs’. On clinical examination, the emaciated patient (body mass index 15.8) was in a compromised clinical condition with bilateral ankle oedema. Laboratory tests revealed several pathological values including low albumen 15 g/l (reference level: 34–48) and severe pancytopenia (haemoglobin 4.5 g/dl, reference 12–16; white blood cell count (WBC) 3.6/nl, reference 4–10, platelet count (PLT, 61/nl, reference 140–400). Mean corpuscular volume (MCV, 80.2 fl) was at the lower limit of the reference level (80–99).
Upper gastrointestinal endoscopy showed a striking picture …